Inspection on 18/01/08 for High Haven

This inspection was carried out on 18th January 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

High Haven 18/08/06

High Haven 10/11/05

High Haven 15/06/05

High Haven 09/11/04

High Haven 25/05/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE High Haven Howdale Road Downham Market Norfolk PE38 9AG Lead Inspector Mr Pearson Clarke Unannounced Inspection 18th January 2008 10:40 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address High Haven DS0000035183.V358706.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. High Haven DS0000035183.V358706.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service High Haven Address Howdale Road Downham Market Norfolk PE38 9AG Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01366 382205 01366 385586 www.norfolk.gov.uk Norfolk County Council-Community Care Mrs Susan Kathleen Settle Care Home 38 Category(ies) of Dementia - over 65 years of age (8), Old age, registration, with number not falling within any other category (30) of places High Haven DS0000035183.V358706.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. People who need wheelchairs to assist with independent mobility at point of admission should not be accommodated in rooms numbered 2, 3, 8, 101, 102, 107, 138, 139, 140, 148, 150 and 151 (as at 31 March 2003). 18th August 2006 Date of last inspection Brief Description of the Service: High Haven is a care home providing personal care and accommodation for up to 38 older people including eight people who have dementia. It is a local authority home owned by Norfolk County Council. The current fees are £368.72 a week. Extra charges include hairdressing £6, beauty therapist £10, chiropody £10 and newspapers and magazines. These charges are indicated in the pre-inspection questionnaire received from the Manager 26th July 2006. The home is located in the market town of Downham Market, close to the shops, pubs, the post office and other amenities. High Haven is an established two storey, purpose built home. The home’s bedrooms are all single except for one double room. There are five day rooms, a visitor’s room and an activities room. There is a passenger lift. There is a small garden at the front of the building and a large well laid out garden at the rear of the building. A large car park lies to the side. High Haven DS0000035183.V358706.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Care services are judged against outcome groups which assess how well a provider delivers outcomes for people using the service. The key inspection of this service has been carried out by using information from previous inspections, information from the providers ,the residents and their relatives, as well as others who work in or visit the home. This has included a recent unannounced visit to the home and this report gives a brief overview of the service and current judgements for each outcome. The inspector was accompanied by an expert by experience for the site visit and her findings have been taken in to account when forming judgements about the service. What the service does well: What has improved since the last inspection? The provider has developed firm plans to address the need for improvements to the environment and it is understood that work in a number of areas will commence in the near future. Since last inspected a new call bell system has been fitted and at the time of the site visit redecoration and refurbishment of the homes dementia care unit was underway. High Haven DS0000035183.V358706.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. High Haven DS0000035183.V358706.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection High Haven DS0000035183.V358706.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is ( good). That the home is careful to assess those seeking admission to the main home and as a result appropriate admissions are made. The homes rehabilitation unit is providing an effective service in a unit which has the facilities and overall staffing needed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the site visit the inspector discussed the pre admission process with the service manager and care coordinators who were on duty. In addition to this, the most recent admissions to the main home were tracked and records relating to the intermediate care unit were looked at. In respect of the main home a clear written assessment of need was seen and this had been translated into a plan of care. From the discussions with the management team it was clear that there was an understanding of the range of need which could be met and examples were given of the sort of admission which would be High Haven DS0000035183.V358706.R01.S.doc Version 5.2 Page 9 refused. The homes Nordelph rehabilitation unit largely takes referrals from hospital settings and as such the admission assessments are normally not completed by the home, but are provided by external professionals. From discussion with the care coordinator in the unit it was acknowledged that there was the potential to receive inappropriate admissions, but as a general rule the unit was used for people whose needs could be met. The inspector was told that the unit has a success rate in the region of 80 and that this was seen as a good outcome. People who were spoken to had a positive view of the care that they were receiving in the unit. High Haven DS0000035183.V358706.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is ( good). People using High Haven benefit from good care plans, a sound approach to medication and health, with staff that respect their dignity and privacy. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Once again the inspector found good quality care planning in use in the home. A number of plans were looked at during the site visit and these were well constructed with good detail including social histories for the residents concerned. Evidence of review was in place as were risk assessments. The manager confirmed that there is still work to be done to introduce nutritional screening , however this is in hand. The inspector was told that the home receives good support from medical services and the care records indicated an appropriate approach in this area. From observation and the views of those cared for it was apparent that care is delivered with due regard to the High Haven DS0000035183.V358706.R01.S.doc Version 5.2 Page 11 protection of privacy and dignity. The arrangements for the management of medication were inspected and the inspector found secure storage and accurate recording. On the day of inspection an audit of medication was taking place and notifications received from the provider demonstrate that the audit system is working to identify errors in practice. From discussion with a resident and family during the site visit there was a perception that the person concerned may not be being fully involved in decisions regarding the delivery of medication and the care received. This was discussed with the manager on the day who undertook to address this and it is also recommended that efforts are made to assure that other residents do not have similar issues. See Recommendation High Haven DS0000035183.V358706.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is ( adequate ). That residents enjoy a relaxed home where they have control over their day to day lives. Levels of activity are being affected by the reliance on agency staff and therefore residents may not be having as many opportunities for stimulation as they should. Whilst people enjoy a reasonable choice of food those in the dementia unit may not be having their needs satisfactorily met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Feedback received from visitors to the home indicated that they felt it was a friendly home which they were made welcome to when they visited. Residents observed seemed relaxed and at home and felt able to exercise choice and control over their lives. Records of activity and stimulation were inspected and whilst these showed a framework of provision it appeared that this was suffering from the heavy reliance on agency staff which meant that things did not always happen as planned. Whilst people were generally happy with the food served feeling that a good range of choice was available, it was of concern that the residents in the unit for people with dementia were not having their High Haven DS0000035183.V358706.R01.S.doc Version 5.2 Page 13 dietary needs satisfactorily met. Feedback received on the day indicated that staff were concerned that the fish being served was too dry for some residents to swallow. The solution to this was to use some gravy from the meat course to lubricate the food which is not acceptable practice even if done with good intention. As such a requirement is made to review the provision of food in this area to ensure that the diet is suitable for all individuals in the unit. High Haven DS0000035183.V358706.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is ( good). That people benefit from a service where there is a robust approach to complaints and to safeguarding, which helps ensure their overall protection. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the site visit the inspector looked at the services record of complaints. This showed that the last recorded complaint was in July and all complaints were classified as satisfactorily resolved. The provider is known to have a robust complaints process and the records seen were consistent with this. It was difficult to evidence that all staff had received adult protection training as training records had not been satisfactorily maintained. This was discussed with acting manager who is working to establish what training staff have received and undertook to ensure that any deficits are tackled. High Haven DS0000035183.V358706.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is (adequate). That residents enjoy a clean and safe home , which will be much improved when planned work is completed This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the site visit the inspector toured the building and all areas seen were found to be clean free from odour and generally homely. As previously identified the homes environment is not ideal when measured against modern standards. As such requirements were made at the last inspection for the provider to submit improvement plans for a number of areas including toilets and bathrooms. a secure garden and replacement of windows. At first sight it appeared that there had been little progress, however during the inspection the manager was able to evidence that planning was in place to address these High Haven DS0000035183.V358706.R01.S.doc Version 5.2 Page 16 matters with tenders for work having been agreed in some areas. As such no further requirements are made in this area as it is accepted that improvements will be made. Although this will greatly enhance the environment there remain areas of difficulty including a heating system which in many areas offers little control over heating levels. It is also the case that many areas would benefit from redecoration and from some replacement of furnishing. This was discussed on the day and it is understood that these issues will also be addressed. High Haven DS0000035183.V358706.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is ( adequate). That residents benefit from a core team of staff who are safely recruited and generally well trained, however failure to recruit has led to over reliance on agency cover which has affected continuity of care . Whilst overall staffing levels are satisfactory there is a need to ensure adequate cover over the busy lunch time period. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the site visit records relating to staffing were inspected and the views of residents, staff and management were sought. Residents said that they received good quality care from hard working staff and this was consistent with observation on the day. The provider has a thorough recruitment process with all necessary checks in place to help ensure the protection of those cared for. Although the process of recruitment is sound the home is using a high number of agency staff and appears to have been doing so for some time. Whilst it is good that shifts are covered this is not a desirable situation and has the potential to affect continuity of care for residents. This failure to maintain recruitment is clearly linked to the absence of the registered manager for some time and the acting manager confirmed that recruitment was a priority and as High Haven DS0000035183.V358706.R01.S.doc Version 5.2 Page 18 such a move away from the reliance on excessive amounts of agency cover . The home is split into three units, being the rehabilitation unit, the dementia care unit and the remaining home, all of which have their own staff team on a shift. Whilst the overall staffing levels are adequate there was some concern regarding levels in the main home at certain times of the day. Whilst there are normally three staff on duty in this area, it is understood that when occupancy is low some parts of the day are dropped to two staff with permanent shifts not covered. This was the case on the day of the site visit with numbers reducing to two from late morning until late afternoon. One effect of this was to reduce the level of supervision that could be given at lunch time and observation of the lunch time meal indicated some areas of concern arising. As such one resident who clearly would have needed a lot of encouragement and help to eat did not receive this and other people spent large periods of time without supervision. From discussion with staff it was apparent that although overall numbers of residents were not high at the time there were a number needing two staff for care particularly in the run up to, and over the lunch time period.. As a result it was not possible to give the care needed to all concerned and a requirement to ensure adequate staffing at this time is made. The provider is known to have a positive approach to staff training, however as a result of the absence of the manager it was difficult to find evidence that all necessary training had been updated although work was on going at the time of the site visit to identify areas of deficit. High Haven DS0000035183.V358706.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 Quality in this outcome area is ( good). That the absence of the homes registered manager has had a negative impact on the running of the home, however the temporary management arrangements are working well and helping to tackle identified shortfalls. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since last inspected the registered manager of the home has been on an extended period of absence which understandably has had an impact on the delivery of management function. During the site visit the views of staff and others were sought regarding this issue. As such it was clear that many aspects relating to management had suffered and that these had impacted on High Haven DS0000035183.V358706.R01.S.doc Version 5.2 Page 20 service delivery. In particular the failure to recruit staff had, and continues to have a negative effect, however this issue is largely addressed in the staffing section of this report. Management systems and records had also been neglected as had staff supervision. Whilst these have been significant issues the home has had temporary management arrangements for the last few months, with an experienced manager from another home seconded to provide cover. Since commencing it was clear that much work has been undertaking to address many of the problems arising from the absence and from the views expressed and observation this has been a necessary and positive experience. In some areas such as quality assurance, processes are well overdue, however this was acknowledged and will be addressed in due course. Financial records relating to residents monies were seen and in order and there were no indicators that health and safety were not being appropriately managed. It was noted that the home was and has been without administrative support for some time and this is highly likely to have contributed to the problems in maintaining management systems. This was discussed on the day and it was understood that an appointment had been made, but there were now doubts about the person starting. Should there still be a vacancy then addressing this should be a priority. Given the unsettled recent situation then the inspector considers that it is possible that relatives may still be unsure of whom to talk to and may be needing to discuss aspects of the care delivered. As such it would be good practice to write to all concerned inviting them to make contact if they need to do so. See recommendation High Haven DS0000035183.V358706.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x x x x x x 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 High Haven DS0000035183.V358706.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP15 Regulation 16 (i) Requirement That the provider review the provision of food served in the dementia care unit to ensure that is suitable for those living there. That The provider ensure that satisfactory staffing levels are maintained so as to meet the needs of residents during the lunchtime period Timescale for action 29/02/08 2 OP27 18 18/01/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations That staff review with residents and or relatives the degree to which their current care plan reflects their needs and wishes. High Haven DS0000035183.V358706.R01.S.doc Version 5.2 Page 23 2 OP32 That the acting manager make arrangements to contact residents families/representatives to ensure that they are fully aware of the current management arrangements and inviting contact if their are any concerns. High Haven DS0000035183.V358706.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI High Haven DS0000035183.V358706.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!